LAKE 2012: National Conference on Conservation and Management of Wetland Ecosystems 06 th - 09th November 2012

L AK E 2 01 2

School of Environmental Sciences Mahatma Gandhi University, Kottayam, Kerala

In association with

Energy and Wetlands Research Group, Centre for Ecological Sciences, Indian Institute of Science, Bangalore

&

Advanced Centre of Environmental Studies and Sustainable Development, Mahatma Gandhi University, Kottayam, Kerala

REGISTRATION FORM
(Mail this form with DD/with UTR number with name (in case of bank transfer) to The Convener, LAKE 2012, School of Environmental Sciences, Mahatma Gandhi University, Kottayam, Kerala 686 560, Email-mgulake@gmail.com)

1. 2. 3.

Name of the Participant Designation Mailing Address

: : :

... ... ...

.. 4. 5. 6. 7. Phone E-mail Fax Accommodation Required If yes please tick the following Dormitory (<Rs 200) 8. 9. 10. 11. 12. 13. Food Name of Spouse/Children if accompanying Date and mode of arrival at Kottayam Date and mode of departure Details of registration : Budget (<Rs 600) Middle end (Rs.600-1500) : : : : Vegetarian / Non-Vegetarian ... ... ... High end (> Rs. 1500) Yes No : : : ... ... ...

Delegates (Rs.2500) / Research Scholars and students* (Rs. 1500)/ Accompanying person (Rs.1500) :

Mode of registration fee payment with details

(Either through Demand draft In favour of The Convener, Lake 2012, M.G.University, Kottayam [OR] Bank transfer through NEFT in to our account number 67191738224 with State Bank of Travancore,

M.G.University Campus branch, Kottayam IFSC Code: SBTR0000669)

14.

Presentation

Oral

Poster

Participation only

Title of the Paper: .. Date : Place : *Supporting documents from HOD/Principal should be attached Signature: